U.S. Senator Tammy Baldwin Statement on Vote for
MilCon/VA Appropriations Act of 2016

WASHINGTON, D.C. - U.S. Senator Tammy
Baldwin released the following statement after voting for the Military
Construction and Veterans Affairs and Related Agencies Appropriations
Act of 2016,
which passed the Senate 93-0.

“I
am voting for this legislation because it rolls back devastating budget
cuts to veterans and includes many reforms that I have fought for and
support. As a member of the Appropriations
Committee, I fought to include provisions in this legislation that
would improve transparency of VA Office of Inspector General reports,
strengthen protections for whistleblowers, and provide stronger
oversight of the VA’s prescribing practices. These are
significant reforms that take a serious step in the right direction to
ensure we address underlying challenges at the VA.”

The bill provides $79.7 billion in
discretionary funding, which includes an additional $2 billion that was
made available by the recently enacted Bipartisan Budget Act of 2015,
which Senator
Baldwin supported. This legislation allowed Congress to avert budget
cuts by raising caps on spending for federal programs that support
critical needs, such as veterans and our military installations.

Senator Baldwin Provisions Included in the FY16 MilCon/VA Appropriations Bill:

Whistleblower Enhancement for VA Medical Professionals: Would
close an existing legal loophole that harms
VA medical professionals who have experienced whistleblower retaliation
in the form of a negative personnel evaluation. Currently, the Office
of Special Counsel (OSC) cannot investigate these types of retaliation
because VA medical professional personnel evaluations
are governed by Title 38; while OSC’s relevant investigatory power is
limited to personnel evaluations governed by Title 5. Senator Baldwin’s
provision would address this inconsistency in the law by including
personnel reviews governed by Title 38 within the
scope of potential retaliatory personnel actions that OSC can
investigate.

Revision of Joint VA and DoD Clinical Practice Guidelines: To
help address the prescription drug abuse and
overdose epidemic, Senator Baldwin included a provision requiring the
VA, working with DoD, to update the joint VA-DoD Clinical Practice
Guideline (CPG) for the Management of Opioid Therapy (OT) for Chronic
Pain, which has not been updated since 2010. In addition,
to ensure prescribers have the most up-to-date science, VA will be
required to adopt the safe opioid prescribing guidelines for chronic,
non-cancer pain in outpatient settings currently being developed by the
Centers for Disease Control and Prevention (CDC).

Expansion of Opioid Receptor Antagonists: Opioid
receptor antagonists, such as naloxone, are drugs that reverse
the effects of opioids, including respiratory depression, and, in
certain cases, can prevent death. Indeed, the VA’s year-old Overdose
Education and Naloxone Distribution (OEND) program, which dispenses
take-home naloxone kit prescriptions to at-risk veterans,
has been credited with saving 33 lives by reversing opioid overdoses.
Senator Baldwin included a provision to expand this program, ensuring
every VA medical facility is equipped with opioid receptor antagonists,
as well as improve provider and pharmacist education
on overdose prevention strategies.

Joint Executive Council Working Group on Opioids and Pain Management: Senator
Baldwin authored a provision
to create a new joint VA-DoD working group to focus on patient pain
management and opioid therapy. This working group would be established
within the DoD-VA Joint Executive Council—an existing forum for senior
leadership at both Departments to develop policies
and programs to address overlapping priorities—and would cover, at
minimum, opioid prescribing practices, acute and chronic pain
management, complementary and integrated health, and the concurrent use
of opioids and prescription drugs for mental health issues,
including benzodiazepines. The working group would help combat the VA’s
continued overreliance on opioids for pain management; limit instances
of VA providers prescribing opioids for mental health treatment, which
is non-compliant with joint VA-DoD Clinical
Practice Guidelines; and improve patient care during the DoD-VA
transition.

Enhancing VHA Opioid Reduction Efforts: VA
has had some success reducing the use of opioids to treat pain,
including through the Opioid Safety Initiative (OSI) and the use of the
Opioid Therapy Risk Report tool. However, capability gaps exist in
these initiatives, and more needs to be done. To help reduce rates of
opioid addiction and fatal overdose, it is critical
that real-time data is available at the individual prescriber and
pharmacist level as well as the pharmacy management level to prevent
inappropriate prescribing before it occurs.

Senator
Baldwin included a provision that directs the VA to develop and deploy
mechanisms for including real-time patient information on existing
opioid prescriptions within VHA as well as
patient controlled substances prescription information in the state
prescription drug monitoring program. The mechanisms must also alert a
provider or pharmacist in real-time that an opioid or benzodiazepine
prescription would be inappropriate and protect
against “double-prescribing” when an in-patient continues to receive
take-home opioid prescriptions despite being treated with opioids at a
VA facility. The provision further directs VA to submit information on
controlled substances prescriptions to state
prescription drug monitoring programs.

GAO Audit of VA Opioid Therapy: The Center
for Investigative Reporting has noted that prescriptions for four
opiates – hydrocodone, oxycodone, methadone and morphine – have
increased by 270 percent in the past 12 years. This drastic increase has
also been seen in local VA facilities, including the Tomah VAMC in
Wisconsin. To strengthen oversight of VA opioid prescribing
practices, Senator Baldwin included a provision directing the
Government Accountability Office, in consultation with the Department of
Veterans Affairs, to report to Congress on the effectiveness of the VA
Opioid Safety Initiative and overall opioid prescribing
practices throughout the VA system. This report shall include
recommendations on improvements to the Opioid Safety Initiative, deaths
involving veterans prescribed opioids, overall opioid prescription
rates and indications at all VA facilities, including
facilities and prescribers that are among the top ten percent in the
nation regarding the percent of their patient population receiving
opioids and the average dose per patient. In addition, the report shall
note the use of benzodiazepines and opioid concomitantly
and their prescription rates and indications along with facilities and
prescribers that are among the top ten percent in the nation regarding
the percent of their patient population receiving opioids and the
average dose per patient.

VISN Pain Management Boards and Complementary and Integrative Health: To
further help reduce the inappropriate
use of opioids for chronic pain and increase the use of complementary
and integrative health, Senator Baldwin included a provision that
encourages the VA to establish a pain management board within each
Veterans Integrated Service Network (VISN) comprised
of health care professionals and—to give veterans a greater role in
their care—veteran patients and/or family members of a veteran patient.
The pain management boards would serve as a resource for the region’s
facilities, patients, and family members; provide
best practices recommendations for pain management to the VA facilities
within its region, including patient, family member and medical
perspectives; provide an annual report to the Secretary of Veterans
Affairs about pain management practices within its region,
which would then be sent to Congress.

VA Inspector General Transparency Improvements: Senator
Baldwin, along with Appropriations Subcommittee on
MilCon/VA Chairman Mark Kirk (R-IL), authored a provision regarding
increasing transparency at the VA Office of Inspector General (OIG).
Based on an amendment Senator Baldwin included in S.579, the Inspector
General Empowerment Act, the joint Baldwin-Kirk
amendment would amend current law to ensure that when the VA OIG
completes a report, it is promptly shared with the VA Secretary,
Congress, and the public. This bill language would help address failures
of transparency and agency oversight by requiring recommendations
made by the VA OIG during investigations, audits or other reports to be
sent directly to the VA Secretary. In addition, these recommendations
would be available to the public and submitted directly to relevant
Congressional oversight committees. Lastly, if
the Inspector General initiated an investigation based on information
provided by an individual, the recommendations would also be shared with
that individual.

GAO Report High Risk List: In
2015 GAO placed VHA on its annual High Risk List, identifying VHA
programs
as high-risk due to their greater vulnerabilities to fraud, waste,
abuse, and mismanagement or the need for transformation to address
economy, efficiency, or effectiveness challenges. Accordingly, Senator
Baldwin included language to require the VA Secretary
to issue to Congress quarterly progress reports on Department action to
address GAO findings and recommendations.

Armed Forces Retirement Home (AFRH): The
bill includes a provision authored by Senator Baldwin requiring
the AFRH to report on actions taken to implement recommendations made
by the Department of Defense Inspector General (DoD IG) in a July 2014
report.

About Me

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